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Spectrum of Imaging Findings After Intestinal, Liver-Intestinal, or Multivisceral Transplantation: Part 2, Posttransplantation Complications

¹ Department of Pediatrics, Leopold-Franzens University, Anichstrasse 35, Innsbruck A-6020, Austria.
² Department of Radiology, Leopold-Franzens University, Innsbruck, Austria.
³ Department of General Surgery and Transplantation Surgery, Leopold-Franzens University, Innsbruck, Austria.

View larger version (90K): [in a new window]   Fig. 1C. —41-year-old woman after multivisceral transplantation necessitated by Gardner's syndrome and intraabdominal desmoid tumor. Eight months after operation, clinical findings were suggestive of intestinal obstruction. Helical CT scan obtained without IV but with oral contrast material shows dilated nonthickened loops of intestinal graft (asterisks) and air-fluid level, which is consistent with intestinal dysmotility.

View larger version (136K): [in a new window]   Fig. 2. —59-year-old man with short-bowel syndrome who underwent upper gastrointestinal examination with water-soluble contrast material 17 days after intestinal transplantation using side-to-end jejunojejunal anastomosis. Image shows contained contrast leakage (open arrow) of recipient jejunal stump with staple line (solid arrow). Donor jejunum (solid arrowheads), recipient duodenum (asterisk), and recipient jejunum (open arrowheads) are also visible.

View larger version (153K): [in a new window]   Fig. 1D. —41-year-old woman after multivisceral transplantation necessitated by Gardner's syndrome and intraabdominal desmoid tumor. Thirty-four months after operation, clinical findings were suggestive of intestinal obstruction. Radiograph obtained during enema with water-soluble contrast material displays concentric high-grade stenosis of ileorectal end-to-side anastomosis (arrow). Air-filled recipient rectal stump (open arrowheads), contrast-filled distal rectum (asterisk), and donor ileum (solid arrowheads) are depicted.

View larger version (73K): [in a new window]   Fig. 3A. —3-year-old girl after intestinal transplantation necessitated by short-bowel syndrome (A-D), graft failure (B-D), and subsequent retransplantation utilizing multivisceral graft (E and F). Contrast-enhanced helical CT scan obtained 26 months after initial intestinal transplantation shows unspecific focal wall thickening of intestinal graft and reduced contrast enhancement (arrows) compared with nonthickened regular contrast-enhanced intestinal loops (arrowheads), which is consistent with focal intestinal ischemia. Ascites (asterisks) is depicted.

View larger version (88K): [in a new window]   Fig. 3B. —3-year-old girl after intestinal transplantation necessitated by short-bowel syndrome (A-D), graft failure (B-D), and subsequent retransplantation utilizing multivisceral graft (E and F). Contrast-enhanced MDCT scan obtained 3 years after operation displays complete acute thrombotic occlusion of portal vein (arrow) and nonenhancement of spleen (asterisk), indicating infarction. Gastric tube (arrowhead) is also visible.

View larger version (90K): [in a new window]   Fig. 3C. —3-year-old girl after intestinal transplantation necessitated by short-bowel syndrome (A-D), graft failure (B-D), and subsequent retransplantation utilizing multivisceral graft (E and F). Contrast-enhanced MDCT scan obtained 3 years after operation also shows thin-walled pancreatic pseudocyst (solid arrowheads) and focal ductal dilatation of pancreatic body (single arrow). Ascites (black asterisk), splenic infarct (white asterisk), and unspecific focal gastric wall thickening (double arrows) are also depicted. Open arrowhead = surgical clip.

View larger version (84K): [in a new window]   Fig. 3D. —3-year-old girl after intestinal transplantation necessitated by short-bowel syndrome (A-D), graft failure (B-D), and subsequent retransplantation utilizing multivisceral graft (E and F). Contrast-enhanced MDCT scan obtained 3 years after operation shows contrast enhancement of donor superior mesenteric artery (black arrow) but nonenhancement of graft arteries and intestinal wall (solid arrowheads), indicating chronic vascular occlusion. Note additional intraabdominal abscess (open arrowheads) draining via cutaneous fistula (between white arrows).

View larger version (80K): [in a new window]   Fig. 3E. —3-year-old girl after intestinal transplantation necessitated by short-bowel syndrome (A-D), graft failure (B-D), and subsequent retransplantation utilizing multivisceral graft (E and F). Contrast-enhanced MDCT scan obtained 3 years after initial intestinal transplantation with graft failure and 8 weeks after subsequent multivisceral transplantation with normal graft function shows acute thrombosis of inferior vena cava (single arrow) at level of renal veins. Normal enhancement and appearance of intestinal graft (black asterisks) as well as hyperdense prosthetic mesh inlay (double arrows) for abdominal wall repair are noted. The following donor anatomic structures are shown: celiac trunk (single solid arrowhead), duodenum (white asterisk), pancreas (double open arrowheads), superior mesenteric artery (double solid arrowheads), and superior mesenteric vein (single open arrowhead).

View larger version (82K): [in a new window]   Fig. 3F. —3-year-old girl after intestinal transplantation necessitated by short-bowel syndrome (A-D), graft failure (B-D), and subsequent retransplantation utilizing multivisceral graft (E and F). Contrast-enhanced MDCT scan obtained 3 years after initial intestinal transplantation with graft failure and 8 weeks after subsequent multivisceral transplantation with normal graft function displays dissection membrane (arrow) in abdominal aorta. Asterisks = intestinal graft loops.

View larger version (118K): [in a new window]   Fig. 4A. —39-year-old woman after intestinal transplantation necessitated by Gardner's syndrome with intraabdominal desmoid tumor (A) and graft failure and subsequent retransplantation utilizing multivisceral graft (B and C). Contrast-enhanced MDCT scan obtained 2 months after initial intestinal transplantation displays multiple intraabdominal abscesses (asterisks) with air-fluid level and contrast-enhancing abscess membrane. Mesenteric lymphadenopathy (open arrowhead), partly thickened wall of intestinal graft (solid arrowhead), and recipient descending colon (double arrows) are depicted.

View larger version (90K): [in a new window]   Fig. 4B. —39-year-old woman after intestinal transplantation necessitated by Gardner's syndrome with intraabdominal desmoid tumor (A) and graft failure and subsequent retransplantation utilizing multivisceral graft (B and C). Contrast-enhanced MDCT scan obtained 2 months after retransplantation that used multivisceral graft displays multiple intrahepatic focal hypodensities (arrows), which is consistent with nocardial abscesses. Also, note fluid-filled stomach (asterisk) and small intraabdominal abscess (arrowhead).

View larger version (116K): [in a new window]   Fig. 5. —Contrast-enhanced MDCT scan obtained 6 weeks after intestinal transplantation in 39-year-old man with short-bowel syndrome who presented with acute sepsis syndrome. Image shows large ventral abdominal wall defect (between arrows) due to dehiscence and subsequent operative widening of median laparotomy, intraabdominal abscess (asterisks) with air bubbles (white arrowheads), and cutaneous drainage (arrows). Also seen are intestinal graft enlargement due to edematous infiltration, engorgement of mesenteric vessels, and increased contrast enhancement of intestinal wall (black arrowheads), all of which are consistent with surgically proven peritonitis.

View larger version (82K): [in a new window]   Fig. 6B. —67-year-old man after multivisceral transplantation necessitated by liver cirrhosis, intrahepatic hepatocellular carcinoma, chronic thrombotic occlusion of portomesenteric venous system, and clinical evidence of infection. Contrast-enhanced helical CT scan obtained 4 weeks after operation displays unspecific enlargement of mesenteric lymph nodes (arrows) of intestinal graft. Ascites (asterisks) and calcification of iliac artery (arrowhead) are also visible.

View larger version (95K): [in a new window]   Fig. 4C. —39-year-old woman after intestinal transplantation necessitated by Gardner's syndrome with intraabdominal desmoid tumor (A) and graft failure and subsequent retransplantation utilizing multivisceral graft (B and C). Contrast-enhanced MDCT scan obtained 3 months after retransplantation that used multivisceral graft shows nonenhancement of intestinal graft (lower white arrows) except proximal jejunum (black arrow), focal intramural pneumatosis (white arrowhead), and free intraabdominal air bubble (black arrowhead) due to arterial thrombosis with ischemia and perforation. Localized fluid (white asterisk) with cutaneous fistula (between upper white arrows) is also depicted.

View larger version (90K): [in a new window]   Fig. 1A. —41-year-old woman after multivisceral transplantation necessitated by Gardner's syndrome and intraabdominal desmoid tumor. Contrast-enhanced helical CT scan obtained 10 days after operation because laboratory results provided evidence of acute hemorrhage displays mesenteric pseudoaneurysm (solid black arrowhead) with localized contrast extravasation (open arrowhead) and mesenteric hematoma (black asterisk). Intestinal graft lumen (white asterisks), mesenteric arteries and veins of intestinal graft (arrow), and postoperative changes in abdominal wall (between white arrowheads) are also shown.

View larger version (91K): [in a new window]   Fig. 1B. —41-year-old woman after multivisceral transplantation necessitated by Gardner's syndrome and intraabdominal desmoid tumor. Six weeks after operation, intestinal graft function was normal. Helical CT scan obtained after administration of oral and IV contrast material shows large loculated fluid collection (white asterisk) with displacement of intestinal graft loops (black asterisks). Subsequent imaging-guided drainage revealed lymphocele. Postoperative dressing of ileostomy (arrows) is also depicted.

View larger version (99K): [in a new window]   Fig. 7A. —5-year-old girl with short-bowel syndrome 4 months after intestinal transplantation who presented with newly developed ascites. Arrowhead = gastric tube. Unenhanced MDCT scan shows fatty liver degeneration (asterisk) and focal hyperdensity (double arrows) in left liver lobe.

View larger version (96K): [in a new window]   Fig. 7B. —5-year-old girl with short-bowel syndrome 4 months after intestinal transplantation who presented with newly developed ascites. Arrowhead = gastric tube. MDCT scan obtained after contrast enhancement reveals additional focal intrahepatic hypodensities (single arrows), which represent pathologically proven multifocal posttransplantation lymphoproliferative disorder. Contrast-enhancing inferior vena cava (arrowhead) is also shown. Double arrows = hyperdensity.

View larger version (108K): [in a new window]   Fig. 6A. —67-year-old man after multivisceral transplantation necessitated by liver cirrhosis, intrahepatic hepatocellular carcinoma, chronic thrombotic occlusion of portomesenteric venous system, and clinical evidence of infection. Contrast-enhanced helical CT scan obtained 2 weeks after operation shows enlargement of pancreatic head with reduced contrast enhancement (white arrow), which is consistent with edematous pancreatitis. Ascites (black asterisks) and periportal lymphedema (black arrows) are also revealed. Arrowhead = gastric tube, white asterisk = stomach.

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